Welcome to Montage Health’s application process!

Job Description:

The Customer Service Representative is responsible for answering telephone inquiries and responding to correspondence from employer clients, members and providers regarding eligibility, claims status and benefit determinations.

Responsibilities

• Intake all customer (provider, member and health plan) calls as they relate to inquiries and grievances.

• Explain health insurance benefits, policies and procedures to members and providers, i.e., claims submission, appeal process, medical review, documenting all communication.

• Investigate timely filing of provider claims.

• Serve as a point of contact and liaison for customers.

• Successfully implement dispute resolution.

• Provide proactive and event-related education to customers.

• Facilitate customer care as appropriate.

• Assure accurate and timely response to all customer inquiries.

• Log calls and document action plans.

• Successfully bring all issues to closure within appropriate timeframe.

• Proactively identify areas of improvement and provide feedback.

• Perform member and provider satisfaction surveys as appropriate.

• Provide support and coverage to interdepartmental staff as needed.

• Coordinate customer grievances with appropriate department.

• Develop strong partner relationship with customers.

• Perform other activities and functions as defined by the Claims Manager.

Position Requirements

• Minimum A.A. degree or equivalent practical experience in related or similar positions.

• At least two years' experience in customer service/call center within the managed care, insurance, healthcare, or related call center environment

• Strong comprehension skills

• Ability to communicate effectively, including written and verbal communication skills

• High level of attention to details in obtaining complete and accurate information

• Problem resolution skills

• Strong interpersonal and negotiation skills

• Ability to key data accurately and rapidly

• Basic knowledge of insurance terminology and medical coding, e.g. ICD and CPT

• Ability to operate computer equipment and software programs necessary to fulfill position responsibilities

• Working knowledge of Microsoft office products including Outlook, Word, and Excel

• Ability to interact professionally with co-workers, providers, clients, brokers and management-level staff.

• Excellent phone manner and ability to handle multiple phone lines.

• Must be able to meet established deadlines

Pay rate: $23.00 an hour

Equal opportunity employer.

Assigned Work Hours:

8:00am - 4:30 pm

Position Type: